Rotator cuff tears often require reattachment of soft tissue to skeletal structures and the explanation of the invention as hereinafter set out refers particularly to the repair of rotator cuff injuries, although it must be understood that the invention can be employed also in association with other like injuries where similar repair techniques are ordinarily employed or considered. The rotator cuff is the anatomical term given to a group of muscles and their tendons that act to move and stabilize the shoulder. These muscles extend from the scapula, i.e. the shoulder blade bone, and connect to the humerus, i.e. the upper arm, via their tendons, forming a cuff at the shoulder joint, thus serving to control different arm movements. A rotator cuff tear can result from a trauma to a shoulder or through wear and tear and be associated with one or more tendons becoming torn, leading to pain, shoulder instability and/or restricted arm movement.
Rotator cuff repair involves a surgeon reattaching each damaged tendon to the humerus. The conventional surgical process typically includes the steps of gaining access to the injured rotator cuff by making an incision in the shoulder and splitting the deltoid muscle and then removing scar tissue that has built up on each torn tendon. The surgeon then creates a trough at the top of the humerus and drills small holes through the bone, whereafter he sews the tendon to the bone with sutures passing through the holes. Other steps also may be associated with the process in order to deal with specific repair requirements. Following the process, the arm is incapacitated and healing is allowed to occur, which involves the reattachment of the tendons to the bone and which is generally a slow process.
Instead of passing sutures through holes drilled in the humerus for securing the tendon to the humerus, it is also known to use permanent anchors with sutures attached, inserted in the humerus, for this purpose.
More recently, arthroscopic surgery is being employed for rotator cuff repair. The surgery is performed through one or more small incisions. The surgeon observes the area of interest via a display screen which displays live images from a camera that is placed in a tube (cannula) passing through a small incision into the joint space. The instruments used are thin and are contained in separate cannulas that are inserted into the shoulder via separate small incisions. This arthroscopic surgery process includes placing anchor devices to which sutures are engaged for securing tendons to the humerus. In some techniques a pilot hole is required prior to placement of an anchor device. Each suture is passed through the tendon with a suture passing instrument. In most cases, all of the sutures are passed before tying. The sutures are then tied to anchor devices by the technique of arthroscopic knot tying. Various difficulties are associated with arthroscopic surgery as above envisaged.
The location of and the angle of a pilot hole for an anchor device is difficult to appreciate arthroscopically, rendering the location of anchor devices in their holes difficult.
The tying of sutures arthroscopically is very challenging.
Insofar as suture management is concerned, present techniques often require multiple sutures to be placed in position first and then to be tied to their anchor devices, often creating a “spider web” with entanglement of sutures and resulting in accidental pull-out of sutures and failure to recognize appropriate suture strands to be tied. Placing of sutures also presents difficulties insofar as multiple passes through the tendon are often required and snaring of suture portions by the soft tissue forming a tendon also can occur, resulting in difficulty in retrieving sutures into the portal of the equipment used.